Physicians want to be able to share patient data with other providers

Major physician and healthcare IT management groups are concerned about the U.S. government's timeline and process for rolling out the final phase of electronic health records (EHR).

The American Medical Association (AMA) and the College of Healthcare Information Management Executives (CHIME) have both voiced concerns over "performance thresholds" or expectations for EHRs. The two groups want more flexibility in what are otherwise rigid standards.

The U.S. Centers for Medicare & Medicaid Services (CMS) has dispensed more than $7.7B in reimbursement payments to more than 307,000 healthcare professionals and 4,000 hospitals deploying EHRs under government guidelines.

The federal government requires healthcare facilities eventually to achieve three stages of meaningful use of EHRs over the next five years. To date, Stages 1 and 2 of meaningful use criteria have been defined by the U.S. Office of the National Coordinator of Health IT (ONC), meaning healthcare providers can be certified for compliance.

In November 2012, the HIT Policy Committee released draft recommendations and a Request for Comment for the Stage 3 criteria, which will go into effect in 2016.

Responding to the Request for Comment, CHIME urged the committee in a letter (download PDF) to recommend thorough evaluations of what has been accomplished so far before setting objectives for the nation's hospitals in Stage 3.

"We see no value in setting unrealistic performance thresholds or expectations before current evaluations of what we have accomplished have been undertaken," CHIME wrote. "Every desirable EHR-related objective cannot feasibly be met by 2016, nor do we see any value in attempting the rushed adoption of various EHR uses by that time. Instead, verifiable and continuous progress should be the goal."

Similarly, the AMA cautioned in its own letter (download PDF) that requiring hospitals and eligible healthcare professionals to achieve a 100% pass rate on meaningful use objectives "is not the right approach."

"The current and future meaningful use requirements are problematic, given that failing to meet just one measure by one percent would make a physician ineligible for incentives and subject to financial penalties," AMA CEO James Madara wrote. "The measures for use of EHRs should be made reasonable and achievable and still have a meaningful impact."

The AMA hammered out five points of contention with current proposed meaningful use criteria. In addition to the 100% pass rate requirements, the AMA said a single set of criteria does not fit all situations and program requirements should be appropriately flexible and better structured to accommodate practice patterns and specialties.

The group also complained that the evaluation process, essential to completing the program, is lacking. And it recommended that more attention be paid during the EHR certification process to address physician usability concerns.

Finally, the AMA cited Health IT infrastructure barriers that need to be resolved. For example, Health IT infrastructure under the guidelines does not enable physicians to readily share patient data electronically with other providers, "which is essential for improving the value and efficiency of our health care delivery system."

The total cost for the EHR incentive program is expected to hit $22.5 billion over the next decade, according to the latest estimate provided by the Office of Management and Budget.

Under the American Recovery and Reinvestment Act of 2009, physicians who implement EHR systems and demonstrate that they are engaged in meaningful use of such systems can receive reimbursements of as much as $44,000 under Medicare, or as much as $65,000 under Medicaid. Hospitals can receive funds from both the Medicare and Medicaid programs.

On average, hospitals receive about $4 million in reimbursements. But the largest facilities can expect to receive as much as $12 million, said Dr. Mitch Morris, national leader for health IT at Deloitte Consulting.